Western Canada: The growing impact of homelessness on emergency departments

Good morning. It’s James Keller in Calgary.

People experiencing homelessness make up a disproportionate share of visits to Canada’s emergency departments, where doctors and nurses have become a frequent point of contact.

Homeless people face elevated risks of injury, illness and death and often have nowhere else to turn. And when they are treated, many return to the emergency room – again and again.

A pilot project in Edmonton is seeking to manage these vulnerable patients’ care after they are discharged by creating “transition beds” for them to stay in as staff work to find them housing and other help, such as income support or addiction treatment.

As The Globe and Mail’s Alanna Smith reports, the program is starting with 12 beds opening this month, eventually growing to 36. If the program is a success, the Alberta government hopes to expand it significantly.

Louis Francescutti, an emergency physician at Edmonton’s Royal Alexandra Hospital who is involved in the pilot project, says the program will help reduce ambulance calls and ER visits while also improving outcomes. He calls it historic: “It’s never been done in Canada and I think it’ll set a new standard.”

Dr. Francescutti says there are about 15,000 yearly visits to Edmonton emergency rooms by people experiencing homelessness, with some patients seen two or three times in a single day.

Across Alberta, there were 26,396 visits to emergency departments and urgent care centres by people experiencing homelessness last year. In 2020, there were 24,926. In 2019, there were 24,750.

But those numbers are believed to be an undercount. In fact, while experts and health officials agree that homeless patients are at far greater risk to end up in the ER, it’s been difficult to quantify the scale of the problem.

Molly Hayes reports that this could change because of a requirement that hospitals report data to the Canadian Institute for Health Information, or CIHI, whenever a lack of shelter is mentioned in a patient’s chart.

Under the World Health Organization’s International Classification of Diseases, which is used to track global health statistics, homelessness is coded as Z59.0 – the same way U07.1 is entered for a COVID-19 diagnosis, or S82.2 for a tibia shaft fracture. CIHI has adopted this classification.

The requirement from CIHI to collect the data took effect in 2018, and the agency expects to release national figures for the first time later this year.

However, even when that happens, the picture could be incomplete. Even though hospitals are required to report, front-line workers aren’t required to ask, leading to a patchwork system in which the quality of the data.

And while Dr. Francescutti and others are calling for more consistent tracking of the problem, he also says health officials know more than enough to act, regardless of what the CIHI data shows.

“We know that those numbers are underrepresented,” he said. “But in spite of that, it tells you that there’s enough of a problem that somebody should be pushing the panic button.”

This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.